I have had the F plan for a few years now. Think it was the right decision after a lot of research. Only blip for me is that I am interested ti trying the Omnipod 5 (been MDI, type 1 for ten years) but prescription drug insurance doesn’t cover it other than a Tier 3 or 4. I am switching to the G7 in a few weeks, so it’s a moot point, as the Omnipod is not yet available for the G7 and who knows when it will be bluetoothed to the iphone. But I did research it, and was disappointed to find it was not an option for me.
Hello, Terry.
Do you live in Oregon? I live in Eugene. I am going to be going on Medicare in January with a drug and medigap plan.
I am having diffficulty finding what options I have for Tandem pump supplies as well as my Dexcom CGM and insulin.
Do we only have Byram and Edgepark or are there others. Can I get my insulin at my local pharmacy? Have you been able to locate someone who is dependable. I worked with Edgepark in the past and it was very bureaucratic and my doctor’s prescriptions seemed to get lost on a semi-regular basis. )-: Any guidance would be appreciated.
Hello, Barbara.
Yes, I live in Portland. I can tell you my sources and that may help you. I get my insulin, since I use a pump, from CVS under Medicare Part B. Finding a pharmacy with staff who are familiar with filling out the required digital forms may be your most difficult challenge.
Pharmacists are much more familiar with securing insulin under Part D plans. Since you use insulin in a pump, durable medical equipment (DME), the insulin qualifies as covered under Part B, much the same as many other items in the pharmacy. This is a big advantage since Part B insulin is not subject to the frequent formulary whims of the Part D suppliers. Plus, coupled with a medigap plan, your 90-day supply of insulin will cost you nothing out of pocket.
Since I use a Medtronic insulin pump and Medtronic is a Medicare DME supplier, I get my insulin pump supplies from them. There are third parties who qualify as Medicare DME suppliers, so you may have other choices for Tandem insulin pump supplies.
For Dexcom supplies, I currently use the G6 and require sensors and transmitters. I get them from US Med. They have reliably supplied me every 90 days. Again, it’s under Part B and since I have a Medigap plan, I pay nothing out of pocket.
Good luck with your Medicare start. I find it to be a reliable health insurance provider but you do have stay informed of all the various options and practices. I’m happy to read that you have selected traditional Medicare with a Medigap plan.
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Thanks for your clear comments. I will start MC next year. Just learned some interesting MC related rules regarding HSA plans/funds that I need to check out. (6 month look-back??)
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Here is my info so far on HSAs.
I will start medicare next May 1.
I have contributed to HSA account for past several years.
Today I found out some disappointing news. I may be penalized for a portion of my 2023 HSA contributions, done in 2023. (I did a cash contribution in early 2023 for full year, same as previous years).
Medicare rules imply I can’t do HSA contribution for 6 months prior to MC. Some think this means I could only contribute 10 months worth for 2023, then nothing in 2024, even though I may have a HSA plan for 4 months of 2024 before MC.
Anyone familiar with MC funky rules!!!
Anyone else encounter this or familiar with HSA and start of Medicare?.
I will also be checking with my MC agent.
But heads up in case you are in similar situation.
That is so helpful! Is there a place on the medicare site that i can find out my local choices for insulin - I have used a Rite Aide regularly and it is a preferred provider for my Part D so it would be super easy for me…
I will also call Tandem and see what they can tell me.
I am so grateful for this practical assistance. I love SHIBA people but they have been unable to assist with these sorts of diabetes-specific questions.
I believe that the choices for Medicare Part B insulin coverage are nationwide at all pharmacies that “accept Medicare assignment”. Part B insulin is insulin intended for an insulin pump so it will exclude any basal formulations and include all the usual formulations that the pump manufacturer cites and/or your doctor orders.
I have used Apidra as perscribed by my endo. It has been covered by Medicare Part B and results in no out of pocket payment by me.
Ask your Rite Aid pharmacist (avoid technicians) if their pharmacy accepts Medicare assignment. This means that they will bill Medicare first and typically not require any payment from you if you also carry a Medicare supplemental policy - aka Medigap.
https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare
Hello, again. I am trying to move ahead and locate providers that accept Medicare and seem to be getting stuck. Aargh.
Today, I went to my pharmacy (Rite Aide) that participates in Medicare Part D but does not supply insulin through Medicare Part B. Does this make sense? I explained that when you wear a certain kind of pump insulin is covered through Part B. Do supplies like a small quantity of test strips also go through PartB? However they told me that they did not contract with Medicare for this service. In trying to locate providers using the medicare search engine under durable equipment, they will not even permit me to put in insulin as a choice.
I have identified Edgepark as a supplier for Tandem insulin pump supplies, as well as CGMs, but even locating a mail order place was exceedingly difficult. I know from past experience that the only way to work with Edgepark successfully is to be very faithful around follow-up. Is it true that you need to see your endo every three months?
I have attempted to use your links but always seem to end back at the same Medicare page that does not allow me to put in insulin or for that matter insulin pump supplies.
Thank you again for your guidance.
Barbara
If a pharmacy supplies Durable Medical Equipment (DME) to Medicare beneficiaries then they are capable of supplying insulin under Medicare Part B for most insulin pumps.
Here’s a list of some of the examples of Medicare DME:
Note that “infusion pumps and supplies” is on that list. Insulin is an infusion pump supply. It’s very possible that your local Rite Aid does not supply Medicare DME but often they answer your question out of ignorance. Again the key question you should pose to the pharmacist is, “Does your pharmacy accept Medicare assignment?”
I don’t think you should even mention insulin until they have answered positively to the Medicare DME question and whether they accept Medicare assignment.
I linked to this Medicare page and just put in my zip code and nothing else. It brought up a list of Medicare approved suppliers. Included is the CVS pharmacy that has been supplying my insulin under Part B for many years.
Your difficulty in getting a knowledgeable response is unfortunately very common. Polite persistence and a good listening pharmacist are your allies at this point. You may have more luck with the Pharmacy Benefit Managers like Caremark or Express Scripts.
Realize that insulin pump users are a small minority of all insulin users. Yet our numbers have increased by a lot over the last ten years,
Keep plugging away. The search I described above brought up a local Rite Aid pharmacy (Thrifty Payless) with a note that this pharmacy “charges the Medicare approved amount (so you pay less out of pocket).”
Don’t be afraid to call both CVS and Walgreens if your Rite-Aid effort comes up empty.
As a rule, if you are on Medicare and a pump, you need to see your endo every 90 days (not 3 months) or less. If you are on MDI, you need to see your endo every 180 days (not 6 months) or less
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Do those endo visits need to be in person, or can they be video?
During Covid, tele-visits were allowed. After Covid, most endos phased out these visits so you should check with your endo. Medicare allows tele-visits until December 31, 2024, but there are some exceptions.
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My diabetes doctor visits have been tele-visits. This seems to satisfy my suppliers of insulin, insulin pump supplies and CGM supplies who always check my visit dates and secure chart notes to fulfill all the Medicare requirements.
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Thanks. I am going to work on being persistent.
Doing that search without putting in any specific durable equipment was very helpful. My local Rite Aide did come up so I will try and talk to them again.
For those of us on Tandem pumps, my local Tandem rep gave me these choices for pump supplies:
Byram, CCS Medical, Solara, ADS. I am leaning towards ADS as they specialize in only diabetic supplies and don’t have awful reviews.
It’s been quite depressing for me to see how difficult the system has been to navigate. Thanks again for your help and for all of the community’s help as well.
If anyone in your endo office in patient care deals with suppliers, use them. Setting up with any supplier is a pain unless you know the ropes. Have your endo office deal with the seemingly endless initial frustrations. After the initial account setup, supplies should start to flow quite easily. I am with CCS medical and thrilled with their service.
I wish I had someone in my endo office who knew the ropes!
Do you live in Oregon and wear a Tandem pump by any chance?
I will call CCS Medical in the morning and see if they might be a good fit. Thank you for the lead.
Sorry, I live in Massachusetts
I am also using CCSmed, for tandem pump supplies, and has worked well. Hopefully switch over to MC mid next year will go smoothly, and would stay with CCS.
At last employer, used Byram, and they were good, but my start with them was when COVID hit, and some struggles then.